{"id":1615,"date":"2015-09-11T12:22:48","date_gmt":"2015-09-11T16:22:48","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=1615"},"modified":"2015-09-11T12:22:48","modified_gmt":"2015-09-11T16:22:48","slug":"overnight-admission","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/","title":{"rendered":"Overnight Admission"},"content":{"rendered":"
\"Greg<\/a>

Greg Shumer, MD, is a third-year resident and 2015-16 Co-Chief Resident at the University of Michigan Family Medicine Residency Program in Ann Arbor.<\/p><\/div>\n

BEEEP BEEEP BEEEP BEEEP<\/i><\/b> – <\/span><\/i>I pressed a button to silence my pager and rose groggily from the bed in the on-call room. \u00a0I hadn\u2019t truly been asleep, just catching a quick rest between pages. \u00a0It was 2am. \u00a0I was 19 hours into my shift and, from the looks of the page, there was a new patient ready for admission to our family medicine inpatient service. \u00a0I picked up the phone and called down to the ER to get the full story.<\/span><\/p>\n

\u201cNew admission: 47-year-old male who\u2019s dehydrated and needs IV fluids and pain control before upcoming flight to his home in east Africa. \u00a0He\u2019s got widespread metastatic cancer; oncology thinks days-to-weeks to live, without additional options for treatment. \u00a0Enrolled in hospice last week but hasn\u2019t seen them yet. \u00a0He bought plane tickets for him and his sister, and his plan is to fly home in 2 days to be with his wife and child for the remainder of his life.\u201d<\/span><\/i><\/p>\n

The ER physician’s words echoed in my head as I reviewed the patient’s chart. \u00a0This was not the typical admission to our service. \u00a0I slipped on my white coat and began the long walk from the 8th floor of the hospital down to the basement\u00a0\u2014 the home of the emergency department. \u00a0As the senior night resident, it was my job to admit this man to the hospital.<\/span><\/p>\n

As I approached his room, I remembered a lesson from one of the palliative care specialists in our department. \u00a0He taught that, at the end of life, it\u2019s most important to first determine the patient\u2019s goals and then let those goals guide recommendations and therapy. \u00a0For critically ill patients, we have IV fluids and medications to support dropping blood pressures, oxygen and mechanical ventilation to help with breathing, and strong antibiotics to stave off disease. However, if the patient\u2019s goals are to be comfortable and at home, surrounded by loved ones at the end of life, then these invasive and often-times uncomfortable medical interventions are better left on the sideline, replaced by medications to help make the patient more comfortable.<\/span><\/p>\n

I knocked on his door, waited for permission, and entered. \u00a0Inside the dimly lit room were two people: \u00a0A middle-aged woman adorned in a beautiful light-blue hijab stood and introduced herself as the man\u2019s sister; and the patient, bald and with sagging eyes, laid on the hospital bed looking up at me. \u00a0\u00a0I introduced myself to both of them, glanced at the monitor, saw with relief\u00a0that his vital signs were within the normal ranges, and then sat in a chair next to his bed. He sat up and extended both of his hands towards me, enfolding my right hand in a warm and gentle handshake. He smiled and told me his name. \u00a0Despite these signs of strength, he looked cachexic and weak.<\/p>\n

\u201cWhat are your goals for this hospitalization?\u201d \u00a0I began.<\/span><\/p>\n

\u201cI know I do not have long in this world, and I am at peace with this,\u201d he began. \u00a0\u201cI want to go to my home country to be with my family for my remaining days, but am worried because I have not been able to eat or drink.\u201d<\/span><\/p>\n

BEEEP BEE<\/i><\/b>… I pressed the button to silence my pager and urged him to carry on. Whatever it was, it could wait.<\/span><\/p>\n

\u201cI would like to get fluids to regain my strength,\u201d he continued, \u201cand medication to help with pain and nausea so I can endure the flight to my home.\u201d<\/span><\/p>\n

I nodded in understanding. \u00a0I reviewed his medications and discussed what had worked best for his symptoms in the past. \u00a0I assured him and his sister that our objectives as his doctors would be in line with his goals, and we would aim to get him safely on his flight in 36 hours.<\/p>\n

At the end of our conversation, he smiled at me. \u00a0\u201cThank you for your humanity,\u201d he said.<\/span><\/p>\n

\"tools<\/a>

\u00a9www.tOrange.us Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.<\/p><\/div>\n

I never saw him again. \u00a0I ordered IV fluids, and medications for his pain and nausea. \u00a0I gave sign-out to the morning team to let them know his goals and, when I followed up with the team later that week, was happy to hear that his symptoms had improved and he was able to get the appropriate prescriptions in time to make his flight.<\/p>\n

I played a very small part in his care, but the brief interaction still sticks with me. And, I hope that by doing my part as the overnight resident physician, I helped to make him more comfortable on his journey home.<\/p>\n","protected":false},"excerpt":{"rendered":"

BEEEP BEEEP BEEEP BEEEP – I pressed a button to silence my pager and rose groggily from the bed in the on-call room. \u00a0I hadn\u2019t truly been asleep, just catching a quick rest between pages. \u00a0It was 2am. \u00a0I was 19 hours into my shift and, from the looks of the page, there was a […]<\/p>\n","protected":false},"author":1242,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3],"tags":[25,52,31,33,37],"class_list":["post-1615","post","type-post","status-publish","format-standard","hentry","category-about-residency","category-cases-and-rounds","tag-end-of-life-care","tag-oncology","tag-patient-care","tag-reflections","tag-resident-experience"],"yoast_head":"\nEnd-of-Life Care<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Overnight Admission\" \/>\n<meta property=\"og:description\" content=\"BEEEP BEEEP BEEEP BEEEP – I pressed a button to silence my pager and rose groggily from the bed in the on-call room. \u00a0I hadn\u2019t truly been asleep, just catching a quick rest between pages. \u00a0It was 2am. \u00a0I was 19 hours into my shift and, from the looks of the page, there was a […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2015-09-11T16:22:48+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2015\/07\/AU000_shumer.jpg\" \/>\n<meta name=\"author\" content=\"Gregory Shumer, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Gregory Shumer, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/\",\"name\":\"End-of-Life Care\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2015-09-11T16:22:48+00:00\",\"dateModified\":\"2015-09-11T16:22:48+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/9ad3d7cfe8e2d6a8c18ed300a1853148\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/09\/overnight-admission\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Overnight Admission\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/9ad3d7cfe8e2d6a8c18ed300a1853148\",\"name\":\"Gregory Shumer, MD\",\"description\":\"Greg is a current third-year resident and co-chief at the University of Michigan Family Medicine Residency Program. 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